Atrial fibrillation in cancer, anticancer therapies, and underlying mechanisms.

Atrial fibrillation (AF) is a common arrhythmic complication in cancer patients and can be exacerbated by traditional cytotoxic and targeted anticancer therapies. Increased incidence of AF in cancer patients is independent of confounding factors, including preexisting myocardial arrhythmogenic substrates, type of cancer, or cancer stage. Mechanistically, AF is characterized by fast unsynchronized atrial contractions with rapid ventricular response, which impairs ventricular filling and results in various symptoms such as fatigue, chest pain, and shortness of breath. Due to increased blood stasis, a consequence of both cancer and AF, concern for stroke increases in this patient population. To compound matters, cardiotoxic anticancer therapies themselves promote AF; thereby exacerbating AF morbidity and mortality in cancer patients. In this review, we examine the relationship between AF, cancer, and anticancer therapies with a focus on the shared molecular and electrophysiological mechanisms linking these disease processes. We also explore the potential role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in the management of anticancer-therapy induced AF.

Cholelithiasis in a goat associated with chronic fascioliosis in Bangladesh: A case report and review of literatures.

The objective of the present study was to describe a very rare case of gallstone (cholelithiasis) in a goat associated with chronic fasciolosis. During a routine slaughterhouse-based survey, a two-and-half-year-old female Black Bengal Goat was found to be affected with severe chronic fascioliosis characterized by the massive damage in the liver. Through systemic dissection of liver, we isolated 94 adult Fasciola spp., and by PCR, we confirmed the fluke as Fasciola gigantica. The gallbladder of the goat was oedematous. On opening the gallbladder, we recovered 255 stones of variable sizes. Stones were whitish in colour and friable, and some of the fragile stones were attached to the wall of the gallbladder. To the authors' knowledge, this is the first report of the cholelithiasis in a goat associated with F. gigantica.

Pakistan's Emergency Medical Services (EMS) system & out-of-hospital-cardiac-arrest (OHCA): A narrative review of an EMS system of a low middle income country in context of OHCA.

Pakistan's Emergency Medical Services (EMS) are a critical component of its healthcare system, providing pre-hospital emergency care across a nation with over 220 million people. This article explores the evolutionary journey of Pakistan's EMS, highlighting both the challenges it faces and the strides it has made, with a specific emphasis on patients experiencing out-of-hospital cardiac arrest (OHCA). To extract relevant information, we searched MEDLINE & Embase data bases using MeSH terms "Emergency Medical Services" OR "EMS" AND "Out-of-Hospital-Cardiac-Arrest" OR "OHCA" AND "Pakistan". In addition, we also retrieved information from the EMS leadership in Pakistan through e-mails. We delve into the significance of key performance indicators for OHCA, advocate for the establishment of OHCA registries to improve patient outcomes, address regional disparities in pre-hospital care, and acknowledge the gradual progress of the EMS system.

Need for Staging Investigations in Newly Diagnosed Breast Cancer: Establishing Local Guidelines for Radiological Staging in Bahrain.

Objective: Staging workup and detection of distant metastases is important in newly diagnosed breast cancer in order to make treatment decisions and establish the prognosis. There is wide variation in current recommendations for staging investigations in breast cancer. Routine staging is performed for all patients in Bahrain because of lack of consistent guidelines. Optimization of the criteria for staging is important for identification of metastases, while minimizing harm and costs. The aim of this study was to evaluate factors associated with distant metastases in newly diagnosed patients with breast cancer, in order to establish local guidelines for proper selection of patients for systemic staging. Materials and Methods: Patients with newly diagnosed breast cancer at Salmaniya Medical Complex in Bahrain who underwent staging investigations between January 2016 and December 2022 were identified from a pathology database. Patients with previous history of cancer, synchronous tumors, bilateral breast cancer and ductal carcinoma in situ were excluded. Clinical, radiological and pathological data were retrospectively analyzed. Results: A total of 593 patients underwent staging computed tomography and bone scans or a PET scan. Distant metastases were identified in 20.7% of cases. M1 disease was significantly associated with multifocality/multicentricity, high grade tumors, hormone receptor-negative cancers, high Ki67 index, advanced tumor stage, node-positive disease, triple-negative breast cancer, use of PET scans and those who underwent neoadjuvant chemotherapy. Age was not associated with identification of distant metastases. Conclusion: The prevalence of distant metastases in this population of newly diagnosed patients with breast cancer was higher than previously reported. Routine staging of all patients at presentation was not indicated, especially for asymptomatic patients with early breast cancer. This study identified certain groups of patients with a higher risk of distant metastasis, in whom metastatic workup should be performed. These findings may allow for the development of a local guideline that addresses the question of which breast cancer patients need staging investigations for distant metastases.

Frequency of neuro-imaging in the emergency room in patients with vertigo: A cross-sectional study at a tertiary care hospital in Karachi, Pakistan.

Objective: To determine the frequency of neuro-imaging and the prevalence of positive findings in patients with vertigo visiting an emergency room of a low-middle-income-country, Pakistan. Methods: This is a retrospective cross-sectional study conducted in the emergency room of the Aga Khan University Hospital, a 550 bedded tertiary care teaching facility located in Karachi, Pakistan. The frequency of neuro-imaging in patients visiting emergency room with vertigo during 20 years (2000-2020), their findings and disposition was calculated in percentages. A cost-analysis was performed in Pakistani Rupees & US Dollars to estimate the financial burden. Results: During the emergency room visits for vertigo, neuro-imaging (CT scans, MRIs, or both) was conducted for 159 patients, accounting for 70.98% of the cases. Out of these, 64 individuals (40.25%) received a positive diagnosis, which included acute infarcts, hemorrhages, metastases, space-occupying lesions, and meningeal enhancements. Interestingly, among those with negative findings, the 98 patients faced significantly higher costs, amounting to Rs.4,108,000 ($22,449), in contrast to the positive cases, which incurred Rs.2,496,600 ($13,642). Conclusion: The frequency of obtaining neuro-imaging tests in patients with vertigo were significantly high in our study. In addition, there was a significant financial burden associated with neuro-imaging especially for our low-middle-income country.

Draft genome sequence of multidrug-resistant Escherichia coli MAHK_SCM_BAU_30A strain isolated from a subclinical mastitis cow in Bangladesh.

This study announces the sequence of a multidrug-resistant Escherichia coli MAHK_SCM_BAU_30A strain isolated from bovine subclinical mastitis milk in 2022 in Bangladesh. Our assembled genome had a length of 4,884,948 bp, three plasmids, two CRISPR arrays, five prophages, 51 predicted antibiotic resistance, and 72 predicted virulence factor genes.

Protective roles of vitamin C and 5-aminosalicylic acid on reproduction in acrylamide intoxicated male mice.

Context: Serious health risks have been connected to ongoing, escalating exposure to environmental toxins and one of them is acrylamide (ACR), an organic compound. Although there are many published reports on ACR toxicity, limited information is available regarding the use of two potential antioxidants against ACR-instigated reproductive toxicity. Aims: The study focused on investigating the protective effects of vitamin C and 5-ASA against ACR-incited reproductive toxicity. Methods: A total of 50 male mice aged 4 weeks old were treated for 90 days with different concentrations either of ACR or ACR and vitamin C or ACR and 5- ASA or ACR, vitamin C, and 5- ASA. Key results: ACR significantly reduced serum testosterone level (p = 0.0037), sperm concentration (p = 0.0004), and percentage of sperm motility (p = 0.003), as well as increased sperm abnormality; head (p = 0.0058), tail (p = 0.001), and midpiece (p = 0.0339). Besides, the weight (p = 0.0006) and length (p = 0.0105) of testes, as well as weight (p = 0.0001) and length (p = 0.0021) of epididymis were decreased along with atrophy of seminiferous tubules of the testis, and disintegration of the tubular epithelium of epididymis on ACR exposed mice which were improved by vitamin C and 5-ASA administration. Conclusions: Vitamin C and 5-ASA can potentially mitigate the negative effects of ACR on male reproduction; however, combined application is recommended for better performance. Implications: In Bangladesh, this work is anticipated to address the health benefits of vitamin C and 5-ASA, particularly in improving the reproductive health of males against ACR toxicity.

In vitro antifungal potency of the moronecidin-like peptide against Candida albicans, Candida glabrata, and Candida tropicalis.

Background and Objectives: The aim of this study was to investigate the in vitro antifungal potency of the moronecidin-like peptide against Candida albicans, Candida glabrata, and Candida tropicalis. Materials and Methods: To evaluate the antifungal effect of moronecidin-like peptide, the protocol presented in CLSI M27-A3 and CLSI M27-S4 was used and the minimum inhibitory concentration was determined. Results: The minimum inhibitory effect of moronecidin-like peptide composition was 8 µg/ml for Candida tropicalis and Candida albicans and 32 µg/ml for Candida glabrata. The MIC of nystatin was determined to be 1.25 µg/ml for Candida glabrata and Candida albicans and 0.625 µg/ml for Candida tropicalis strains. The MFC composition of the moronecidin-like peptide was determined for Candida tropicalis and Candida albicans strains 8 µg/ml and for Candida glabrata strain 64 µg/ml. The results of cytotoxicity and hemolysis of the moronecidin peptide test on macrophage showed that moronecidin peptide has no cytotoxicity and toxicity properties. Conclusion: According to the results of the present study, the moronecidin-like peptide could be a new strategy in the treatment of infections caused by Candida strains. The discovery of the exact mechanism of which requires extensive clinical studies in this field.

Combating chlorhexidine allergy in perioperative setting.

Chlorhexidine is labelled as hidden allergen as the health care professionals (HCPs) are unaware of the wide range of products containing chlorhexidine. Adverse events from chlorhexidine allergy can be reduced by appropriate perioperative management especially heeding on positive history during preoperative assessment, awareness regarding this hidden allergen, and educating HCPs on possible chlorhexidine-containing products. The regulatory agencies all over the world have issued recommendations regarding safety and risk of hypersensitivity reactions with chlorhexidine-containing products. The onus lies on HCPs to disseminate this knowledge to the stakeholders. We present a brief update to combat chlorhexidine allergy in perioperative setting.

Electrical conductivity and total dissolved solid of raw milk for the detection of bovine subclinical mastitis.

Background and Aim: Bovine subclinical mastitis (SCM) is highly prevalent among dairy cattle. A cross-sectional study was conducted in Bangladesh to evaluate the performance of electric conductivity (EC) and total dissolved solids (TDS) tests for the detection of SCM. Materials and Methods: We randomly selected 108 milk samples from cows of different breeds in the primary milk-producing region of Pabna and Sirajgonj districts of Bangladesh. Samples were subjected to the California mastitis test (CMT), white side test (WST), electric conductivity (EC), TDS, and culture. A cow was considered positive for SCM if it tested positive in CMT, WST, and culture, whereas a cow was considered negative for SCM if it tested negative in all three methods. These gold standards have been used to evaluate the performance of the EC and TDS tests. The optimal EC and TDS cutoff values for the detection of SCM were determined using the "optimal cutoff" function in R version 4.3.1. Results: The optimal EC cutoff value for SCM detection was found to be 6159 µS/cm or 6.16 mS/cm. A positive likelihood ratio (LR+) of 31.2 and an area under the curve (AUC) of 0.905 were obtained for this cutoff value. The optimal cutoff value for TDS was 3100 mg/L of milk, which resulted in a positive LR+ of 45.5 and an AUC of 0.924. Conclusion: To the best of our knowledge, this is the first study to evaluate the performance of EC and TDS tests in detecting SCM in Bangladesh. These results suggest that EC and TDS tests, which are inexpensive, rapid, and easy to conduct, can effectively detect SCM at the farm level.

Pathological study and molecular detection of zoonotic diseases in small ruminants at slaughterhouses in Mymensingh, Bangladesh.

Background and Aim: Slaughterhouses act as a significant public health hotspot in developing countries like Bangladesh. The study aimed to investigate small ruminants at slaughterhouses for pathological study and molecular detection of important zoonotic diseases. Materials and Methods: A total of 75 goats and 14 sheep were investigated from June 2019 to January 2020 at different slaughterhouses in Mymensingh division, Bangladesh. The targeted diseases were tuberculosis (TB), listeriosis, Q fever, brucellosis, anthrax, toxoplasmosis, hydatidosis, and linguatulosis. The tentative diagnosis was made based on gross and histopathological lesions. Polymerase chain reaction (PCR) was performed to confirm the causal agents of zoonotic diseases using disease-specific primers. Results: Grossly, caseous nodule formation in the visceral organs; enlarged and calcifications of mesenteric lymph nodes (MLNs); hydatid cyst formation in the liver were the predominant lesions observed. Histopathologically, granuloma, caseous necrosis, and calcifications admixed with acid-fast bacteria in the MLNs, liver, spleen, and kidney were seen as suggestive of infectivity due to TB. Septic lymphadenitis mixed with rod-shaped bacteria, doughnut granuloma, fibroplasia accompanied by eosinophils and lymphocytic infiltration in MLNs, and portal granuloma were observed in listeriosis, Q fever, linguatulosis, and toxoplasmosis suspected cases, respectively. The PCR amplified Mycobacterium tuberculosis complex (372 bp), Mycobacterium bovis (600 bp), Listeria monocytogenes (517 bp), Toxoplasma gondii (512 bp), and Coxiella burnetii (687 bp) species-specific amplicons. In addition, linguatulosis and hydatidosis were identified in six and three goats, respectively. Brucellosis and anthrax were not detected in any cases. The slaughterhouse samples were also found to harbor the coexistence of different zoonotic pathogens. Conclusion: Deadly infectious zoonotic diseases in goats and sheep at slaughterhouses may cause widespread public health risks. As a result, more intensive monitoring and epidemiological surveys are required to successfully prevent and control zoonotic diseases.

Identification of peste des petits ruminants virus along with co-infecting diseases of goats in Bangladesh.

Objective: Peste des petits ruminants (PPR) virus is the main infectious cause of goat mortality in Bangladesh, and co-infection may make diseases more severe. This study aimed to detect PPR and co-infecting diseases in goats. Materials and Methods: One hundred goats suspected to be infected with the PPR virus were collected from various areas of Mymensingh district, Bangladesh. A systemic post-mortem examination was carried out on PPR-suspected goats. Lungs, spleen, and lymph nodes (pre-scapular) were used for ribonucleic acid extraction, whereas lungs and mesenteric lymph nodes were used for deoxyribonucleic acid extraction. Seven-pair primer sets were used for molecular detection of pathogens specific for PPR, goat pox, contagious ecthyma (Orf), foot and mouth disease (FMD) virus, Klebsiella sp., and Mycobacterium sp. Reverse transcriptase-polymerase chain reaction (RT-PCR) or polymerase chain reaction (PCR) were used to find the exact cause. Results: Out of 100 PPR-suspected goats examined, 55 goats were confirmed as PPR-detected by RT-PCR. Among the 55 PPR-positive goats, 2 were co-infected with goat pox, 2 with tuberculosis, 10 with Klebsiella sp. infection, and 6 with FMD as detected by PCR and RT-PCR. Moreover, 12 goats were co-infected with PPRV and fascioliasis. Conclusion: About 58% of PPR virus-infected goats were co-infected with other organisms. There is a need to design technology to detect the state of co-infectivity at its early onset and future preventive and therapeutic strategies for co-infecting diseases. This is the first study in Bangladesh to describe co-infecting diseases of goats along with PPR.

Steroid growth promoter modified glucose profile and liver morphology in broiler by altering the localization and expression pattern of hepatic glucocorticoid receptors.

This study explores the impact of dexamethasone (DEX) on the serum glucose profile, morphological attributes of the liver, and the expression of hepatic glucocorticoid receptors (GRs) in the broiler. To conduct this study, four homogenous groups of day-old chicks (DOCs) were used (n = 20 chicks per group); one control group (C), and three treatment groups (T1, T2, and T3). All the groups were maintained on a commercial feed with which 3, 5, and 7 mg DEX (per kg feed) were supplied to the T1, T2, and T3 groups, respectively. Samples were collected on days 7, 14, 21, and 28 of the experiment. The serum glucose profile was measured by spectrophotometry. The livers' morphometric attributes were recorded before being processed and stained with hematoxylin and eosin. The expression pattern of hepatic GR proteins was evaluated by immunohistochemical staining. DEX residue was detected in liver tissue using thin-layer chromatography. Increased serum glucose level was observed in the DEX groups. Fatty liver, hepatic congestion, and decreased morphometric attributes were the critical findings in the DEX groups. Congestion of the central veins, sinusoids, and accumulation of lipid droplets was also observed in the DEX groups. GR proteins were mostly localized in the central vein and cytoplasm of the hepatocytes, the expression of which was found to be upregulated with the increased dose of DEX. The residue of DEX was detected in the liver tissues in the higher dose groups. The findings imply that DEX can substantially alter the blood glucose profile and liver morphology.

Fascioliasis may promote tuberculous infectivity in small ruminants.

Fascioliasis and bovine tuberculosis (TB) are global impediments to livestock development. We investigated the co-infectivity of fascioliasis and TB in small ruminants at slaughter. A total of 84 goats and 16 sheep were investigated from different slaughter houses in Mymensingh city, Bangladesh from June 2019 to February 2020. Grossly, acute fascioliasis was characterized by hemorrhagic tracts in the liver and chronic fascioliasis with biliary cirrhosis and pipe-stem liver. Grossly, seven goats and two sheep were associated with the acute and sixty goats and seven sheep were associated with the chronic phase of fascioliasis. Five goats' livers showed both the acute and chronic phases of fascioliasis. In TB, granulomas with central core of caseous necrosis were seen in the lymph nodes (21), livers (10) and lungs (01) of goats or in the lymph nodes (03) and liver (01) of sheep. Histopathologically, biliary cirrhosis was seen in fascioliasis and granuloma, caseous necrosis and calcification in TB. In co-infection revealed granuloma (TB) with acid-fast bacilli and widespread biliary cirrhosis in the livers of goats (14) and sheep (02). The fragments of the 16S rRNA gene (372 bp, M. tuberculosis complex) and MPB83 gene (600 bp, M. bovis) were detected in the lymph nodes, livers and lungs using polymerase chain reaction. This study showed the existence of co-infectivity of Fasciola and M. bovis in goats and sheep in Bangladesh. Chronic fascioliasis may be associated with establishing tuberculous infection in small ruminants. Therefore, extremely zoonotic bovine TB control programs require active management of fascioliasis.

Fowl typhoid live lyophilized vaccine applied at 3-month intervals protected layer chickens from Salmonella gallinarum infection and prevented cloacal shedding.

Objective: Here, we developed and tested the efficacy of a vaccination protocol based on a commercially available live attenuated Salmonella enterica serovar Gallinarum (Salmonella gallinarum) in layer chickens. Materials and Methods: 50 layer chickens of 16 weeks age were obtained and divided into two groups (n = 25), control and vaccinated. The vaccinated group received Salmonella vaccine at 0.2 ml/bird, s/c route at 16, 18, 30, and 42 weeks of age. At 21 weeks of age, birds from both groups were challenged with S. gallinarum orally at 4 × 107 colony-forming unit per bird. Results: Both rapid serum plate agglutination and enzyme-linked immunosorbent assay demonstrated a rising rate of seroconversion in vaccinated birds across the study period, with a 4% positive rate at 18 weeks, 56% at 21 weeks, 60% at 30 weeks, and 64% at each time point of 42 and 54 weeks. The vaccine showed 100% clinical protection and reduced the Salmonella shedding in the feces and eggs of the challenged birds. On the contrary, the unvaccinated challenged birds showed clinical signs and lesions typical of Salmonella infections with morbidity and mortality rates of 36% and 20%, respectively, and had high rates of Salmonella shedding in feces and eggs. Conclusions: With the proposed vaccination schedule Salmonella shedding was prevented, and a high seroconversion was confirmed. To prevent Salmonella infections in laying flocks, a 3-month interval immunization program is advised starting at the pre-laying stage.

Risk factors for bovine rotavirus infection and genotyping of bovine rotavirus in diarrheic calves in Bangladesh.

Bovine rotavirus (BRV) is considered the leading cause of calf diarrhea worldwide, including Bangladesh. In this study we aimed to identify risk factors for BRV infection and determine the G and P genotypes of BRV strains in diarrheic calves. Fecal samples were collected from 200 diarrheic calves in three districts between January 2014 and October 2015. These samples were screened to detect the presence of BRV using rapid test-strips BIO K 152 (RTSBK). The RTSBK positive samples were further tested by polyacrylamide gel electrophoresis and the silver staining technique to detect rotavirus dsRNA. Risk factors were identified by multivariable logistic regression analysis. The G and P genotypes of BRV were determined by RT-PCR and sequencing. A phylogenetic tree was constructed based on the neighbor-joining method using CLC sequence viewer 8.0. About 23% of the diarrheic calves were BRV positive. The odds of BRV infection were 3.8- (95% confidence interval [95% CI]: 1.0-14.7) and 3.9-times (95% CI:1.1-14.2) higher in Barisal and Madaripur districts, respectively, than Sirrajganj. The risk of BRV infection was 3.1-times (95% CI: 1.5-6.5) higher in calves aged ≤ 5 weeks than those aged >5 weeks. Moreover, the risk of BRV infection was 2.6-times (95% CI:1.1-5.8) higher in crossbred (Holstein Friesian, Shahiwal) than indigenous calves. G6P[11] was the predominant genotype (94.4%), followed by G10P[11] (5.6%). The BRV G6 strains were found to be closest (98.9-99.9%) to Indian strains, and BRV G10 strains showed 99.9% identities with Indian strain. The VP4 gene of all P[11] strains showed >90% identities to each other and also with Indian strains. The most frequently identified BRV genotype was G6P[11]. About 23% of calf diarrhea cases were associated with BRV. To control disease, high-risk areas and younger crossbred calves should be targeted for surveillance and management. The predominant genotype could be utilized as the future vaccine candidate or vaccines with the dominant genotype should be used to control BRV diarrhea in Bangladesh.

Zoonotic diseases appeared to be a major hurdle to successful deer farming in Bangladesh.

BACKGROUND AND AIM: Due to the diversified lifestyle and fancy ecology associated with Chitra deer (Axis axis), deer farming has become popular in Bangladesh. Diseases may be the common constrain of successful deer farming. This study aims to investigate the pathological, bacteriological, and nucleic acid based technologies to identify specific causes of morbidity and mortality of captive deer. MATERIALS AND METHODS: Two deer farms and a park deer (designated as farm A, B, and C) entailing 87, 54, and 20 deer, respectively, showed illness and death constitute the study materials. A total of 42 deer died during this investigation. Following death, routine post-mortem examination, histopathology, impression smear staining, isolation, and identification of bacteria were carried out. Polymerase chain reaction (PCR) and reverse transcription PCR were carried out to safeguard the etiology. RESULTS: Clinically, farm A and B showed the acute phase of illness and park deer showed chronic illness. Case fatality rates were 90%, 92%, and 100% in farms A, B, and C deer, respectively. Pasteurella multocida and Streptococcus pneumoniae were identified from the visceral organs of farm A deer. Farm B deer was infected with Clostridium perfringens type A. Park deer was infected with Mycobacterium tuberculosis and hydatid cyst. CONCLUSION: The infectivity in farm A deer was due to stress as induced by punishing weather. The infectivity in farm B deer was due to feeding a higher volume of protein in the diet. The park C deer may optate infection from companion man and animals living around. The diseases of captive deer identified mainly were zoonotic. It needs extensive veterinary services and specialized technologies to identify these diseases, monitor the infectivity and eliminate the public health important diseases at early onset.

Phytochemical analysis and biological activities of "Cherchoomoro" (Nepeta adenophyta Hedge).

ETHNOPHARMACOLOGICAL RELEVANCE: Nepeta adenophyta Hedge (Lamiaceae) is an endemic therapeutic herb from Astore, Gilgit (Pakistan). This plant species has been reported among the local communities, especially for treating abdominal pain, kidney pain, menstrual pain, headache, and controlling bleeding disorders. Therefore, the scientific basis is provided for the relief of pain as it is used in various pain management among the natives, especially as ethnogynecological herbal remedy. AIM OF THE STUDY: The present study investigates the analgesic and anti-inflammatory effects of the ethanolic extract of N. adenophyta in animal models. Furthermore, the extract was also studied to determine their valuable phytoconstituents. MATERIAL AND METHODS: The biological effects were determined via tail-flick, hot plate, and acetic-acid-induced abdominal writhing methods. At the same time, anti-inflammatory activity was assesed via oxidative burst and antioxidant DPPH assay. Gas chromatography-mass spectrometry (GC-MS), and liquid chromatography-mass spectrometry (LC-MS) techniques were employed to understand the phytochemicals present in the crude ethanolic extract of Nepeta adenophyta. RESULTS: In the current study, Nepeta adenophyta extract exhibited potent analgesic and anti-inflammatory effects on different pain models and indicated that the analgesic effect of N. adenophyta extract is mediated both in central and peripheral ways. Dose-dependent and significant (P < 0.05) increases were shown in pain threshold, at 45 min post-treatment, with 20 and 40 mg/kg of the extract in the tail-flick model. The effects of the extract were similar to aspirin but lower to those by morphine (2.5 mg/kg) in the same tests. The extract (20-40 mg/kg) showed dose-dependent inhibition of writhing with a significant (P < 0.001) increase protection against thermal stimuli in hot plate test as compared to control and similar to aspirin and morphine. Further, the anti-inflammatory activity of the crude in oxidative burst and DPPH assays showed significant inhibitory activity. The chemical profile analysis showed major phytochemicals, including long chain derivatives of alkane and alcohol, phenolics, naphthalene, naphthopyran, androsten phenanthrenone, nepetalactones, flavonoids etc. CONCLUSIONS: Nepeta adenophyta Hedge is suggested as a natural alternative for mild pain relief. Our findings endorse the folklore use of N. adenophyta in different pain managements which can be attributed to the presence of polyphenolic compounds, naphthalene derivatives, flavanoids and nepetalactones etc.

Innovation in emergency medicine; a perspective from a low middle income country, Pakistan.

Creativity and innovation are essential life skills in the 21st century. These skills are even more important in the healthcare sector of a resource limited country like Pakistan. The acquisition and implementation of innovation is necessary in the field of emergency medicine in Pakistan to troubleshoot challenges like rising emergency room visits while facing lack of resources. This article highlights the need of innovation in the field of emergency medicine and some of the activities that took place in our local context to bring innovation to the surface.

Dietary supplementation of Neem (Azadirachta indica) leaf extracts improved growth performance and reduced production cost in broilers.

BACKGROUND AND AIM: Global trend to remove the antibiotic growth promoter (AGP) from animals contributes to the exploration of successful measures to sustain production and reduces the intestinal diseases in the post-AGP era. Plant extracts, therefore, have been used to improve performance and intestinal health. Here, we conducted a study to evaluate the effects of neem (Azadirachta indica) leaf extracts (NLE) as alternatives to AGPs in broiler chickens. MATERIALS AND METHODS: Sixty day-old broiler chicks were assigned to 12-floor pens, each stocked with five birds and divided into three treatment groups of four pens per treatment. The groups were: Negative control, basal diet without additives; positive control, basal diet with antibiotics and vitamins; and NLE treated group, basal diet supplemented with 0.1% aqua extract of neem leaves. RESULTS: Overall feed intake was significantly (p≤0.05) highest in the positive control. Higher body weight, higher dressing percentage, and lower feed conversion ratio were observed in birds treated with NLE compared to the negative control group (p≤0.05) but not the positive control group (p>0.05). There was no significant variation in hematology between different groups. Furthermore, the economic evaluation indicated that the NLE treatment was found cheaper than control and antibiotic treatment in cost-benefit analysis. CONCLUSION: We suggest NLE might be a cheaper alternative to antibiotics in broiler production as indicated by improved body weight and feed efficiency.